HomeMy WebLinkAboutMortgage_Williams (8)��� STATEMENT OF MORTGAGE OR CONTRACT INDI
z FOR DEDUCTION FROM ASSESSED VALUATION
�. ✓ Sta:a Fom� 43709 (RS / 4-03)
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PrescnCed by Depertment of Local Govemment Finance
�V Coun Township Year
INSTRUCTIONS: - File Mark
To be /iled in person or by mail with�the CountyAUditor o! the county where the property is Iocated.�AY 1 3 Z005
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to e eNecfive.
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 oI the year the deA'�on is to be effective.
See reverse side /or addilional instructions and qualificafions. �� �
GIgSON COUNTY AUDITOA
Applicant (owne�or contrect buyer- see restnctions on reverse
(� . \ \ n n
Taxing Distrid
Assessed value of real property as of
March 1, current year
no, what is his / her exacl share of interesl?
Key number / legal description Record number
a 6� 5
_ _ Pagenumber � ��
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? [�Yes ❑ No
� 6b0
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
oi�ea�
of mortgagee or contract seller
Address o( mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder o( mortgage
❑ Mobile Home (IC G1.1-�
Dra�r�er NO. _ca�QQ,� ,.,., _
Address of assignee (number and street, city, state, ZIP code) ' �
cara�rio. �- �38y
...... �.. ....... —
Does applicant own property in any other It yes, what county? What Taxii ��{ 4,�.. :d on
county in Indiana? �+ ��� �J -- ❑ No
f\ na-t_P.w� .. � A,.1 ri . 1 COUNTY AUDITOR
3�]
Signature
in the amounf o/: � -
20 � 20 0� 20 20
� �
County Auditor
�
20
' We certify under the penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
resident of Indiana and owner of ihe aforementioned propeAy on March 1, 20
full name)
applican�
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-72-.07
person